Sexual Health, Disease & Sexually Transmitted Infections

Sexually Transmitted Infections (STIs)

There are two types of sexually transmitted infections (STIs): bacterial and viral. Bacterial infections can be treated and cured with antibiotics and are easier to test for during a routine health care exam. Viral infections cannot be cured but symptoms can be managed with medication. Testing for viral infections is also more complicated with the exception of HIV, which can be tested using a variety of methods.

Online STD Wizard

This online tool is based on the CDC STD treatment guidelines and makes this expert knowledge accessible to the public. No personal information is collected and the “quiz” can be taken online in complete privacy.The Wizard guides users through interactive questions and takes only 5 minutes to complete. At the end, each user receives STD screening advice tailored to their specific risk profile. People who take the quiz can learn about behaviors that may put them at risk. The STD Wizard was developed by the Medical Institute for Sexual Health in collaboration with STD experts in response to demand for online sexual health information.

While this is a fun tool, remember that regardless of your risk level, it is a good idea to get tested for most STIs every 6 months if you are sexually active.

It is important to note that there are other, less common, STIs than those listed here. Most STI screenings only test for the most common or likely STIs. Also, other diseases and infections not classified as STIs are capable of being sexually transmitted.

Prevention

Condoms and other barriers such as dental dams can help prevent the transmission of some STIs including Chlamydia, gonorrhea and HIV; others (like herpes, HPV and syphilis) can still be transmitted even if a condom is used correctly. This is because STIs transmitted by skin to  skin contact are only prevented if the barrier covers the entire infected area. It is important to remember that organic (lambskin) condoms do not protect against STIs.

Fluid bonding is a process where partners in a committed relationship get tested for STIs together, abstain from sex or use condoms and other barrier methods for 6 months, and then get tested for STIs again before agreeing to have sex without condoms.

Fluid bonded partners only have unprotected sex with each other, so as to not bring in the potential for new STIs. Because some STIs, including HIV, may not show up in a test for up to 6 months after infection, this process allows committed partners to know what their STI status is before agreeing to unprotected sex.

The Bacterial Infections

Bacterial Vaginosis (BV)

Bacterial Vaginosis (BV) is a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria.  BV is the most common vaginal infection in women of childbearing age. Check out the CDC information page on BV here.

How It Is Spread – The cause of BV is not fully understood. The vagina normally contains mostly “good” bacteria, and fewer “harmful” bacteria and BV develops when there is an increase in harmful bacteria. Not much is known about how women get BV. Any woman can get BV regardless of sexual activity level. However, some activities or behaviors can upset the normal balance of bacteria in the vagina and put women at increased risk including:

  • Having a new sex partner or multiple sex partners
  • Douching
  • Using an IUD

We know that you can’t get BV from toilet seats, bedding, swimming pools, or from touching objects around them. While we don’t know the link between sexual activity and BV there is always a chance of re-infection from a partner if you don’t seek treatment. BV also increases your risk for contracting other STIs like HIV, chlamydia and gonorrhea.

Symptoms – The main symptom is abnormal vaginal discharge with an unpleasant (some say fish-like) odor, especially after intercourse. Discharge, if present, is usually white or gray. Women with BV may also have burning during urination or itching around the outside of the vagina, or both. See your health care provider as these symptoms could also be signs of another STI or gynecological problem like a yeast infection.

Testing – A health care provider must examine the vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to look for bacteria associated with BV.

Treatment & Prevention – BV can sometimes clear up without treatment, BV is also treatable with antibiotics prescribed by a health care provider. BV can recur after treatment, so it’s important to avoid re-infection from a partner by abstaining from sex until the symptoms go away or treatment is finished.

Chlamydia & LGV (Lymphogranuloma venereum)

Chlamydia is the most commonly reported sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis and LGV (Lymphogranuloma venereum) is a related STD caused by three strains of the same bacterium.

How It Is Spread – Via vaginal, anal, and oral intercourse, as well as passed from mother to child during birth. Carried in vaginal secretions, semen, pre-ejaculate as well as direct contact with LGV lesions, ulcers, or other area where the bacteria is located (during skin-to-skin contact).

Symptoms – According to the Centers for Disease Control and Prevention (CDC), about 75% of women and 50% of men with Chlamydia experience no noticeable symptoms; however the illness can be severe. Early symptoms may begin as early as 5 days after infection and can include cramping, bleeding, painful intercourse, or a yellowish, unpleasant smelling discharge in women; and puss or watery discharge, swollen or tender testicles, or burning during urination in men.

The visual signs of LGV include genital papule(s) (e.g., raised surface or bumps) and or ulcers, and swelling of the lymph glands in the genital area.  LGV may also produce rectal ulcers, bleeding, pain, and discharge, especially among those who practice receptive anal intercourse (bottom). Genital lesions caused by LGV can be mistaken for other ulcerative STDs such as syphilis, genital herpes so it’s important to see your health care provider if you notice any unusual bumps in your genital area.

Chlamydia can lead to infertility in women, and can also lead to Pelvic Inflammatory Disease (PID) in women, a serious and sometimes life-threatening illness. In men, chlamydia may cause sterility.

Testing – Chlamydia, like other bacterial STIs, can be detected through a simple urine test or a swab from the part of the body that is infected (cervix, urethra, rectum or throat). LGV does not have direct testing outside of a clinical setting – meaning you can be tested for Chlamydia but it does not tell you if you have LGV too.

Treatment & Prevention – Chlamydia is easy to treat with antibiotics once it is detected. Regular visits to the doctor can help you diagnose it early to prevent long-term effects. Protect yourself with latex or polyurethane condoms during vaginal or anal intercourse, and dental dams or condoms during oral sex. Avoid sexual contact if you have any discharge or burning urination and see a health care provider.

Gonorrhea

Gonorrhea is by Neisseria gonorrhoeae, a bacterium that can grow in the warm, moist areas of the reproductive tract, (including the cervix, uterus and fallopian tubes), and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.

How It Is Spread – Via vaginal, anal, and oral intercourse. Carried in vaginal secretions, pre-ejaculate, and semen, as well as passed from mother to child during birth.

Symptoms – 80% of women and 10% of men show no symptoms. When symptoms do occur, they can begin within a week of infection. They may include painful urination, puss-like or discolored discharge, and tenderness of the genitals. Rectal infections might include discharge or itching and throat infections are also unlikely to have symptoms besides a sore throat. Later, the infection may cause Pelvic Inflammatory Disease (PID) in women, and can seriously interfere with pregnancy and childbirth.

Testing – Gonorrhea can be detected through a simple urine test or a swab from the part of the body that is infected (cervix, urethra, rectum or throat).

Treatment & Prevention – Gonorrhea can be treated with antibiotics. Protect yourself by using condoms during vaginal and anal intercourse, and condoms or dental dams during oral sex. Avoid sexual contact if you have any discharge or burning urination and see a health care provider. Check out the CDC information page about gonorrhea here.

Syphilis

Syphilis is caused by the bacterium Treponema pallidum and has been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.

How It Is Spread – Via oral, vaginal or anal sexual contact, and from mother to child during birth. Carried in saliva, vaginal secretions, pre-ejaculate, and semen. Basically any direct contact with a syphilis sore.

Symptoms – Syphilis causes open, wet ulcers, often painful, that appear 3 – 10 weeks after infection and last for several weeks. The sores appear wherever the person is infected – genitals, anus, mouth, et cetera. In later phases, the disease can cause hair loss and flu-like symptoms, and eventually leads to neurological damage and death.

Testing – Syphilis is most commonly detected through a simple, safe, and inexpensive blood test. The blood test looks for antibodies which your body produces shortly after the infection occurs. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis during their pre-natal care.

Treatment & Prevention – This disease is easy to treat with antibiotics when it is diagnosed early. Visit the doctor whenever you find new growths or sores on your genitals. Protect yourself with latex or polyurethane condoms during vaginal or anal intercourse, and dental dams or condoms during oral sex. Know your partner’s history, and be honest with your partner about your own. Read the Centers for Disease Control (CDC) Fact Sheet about syphilis by clicking here.

The Viral Infections

Human Papilloma Virus (HPV)

Genital HPV infection is caused by human papillomavirus (HPV). HPV is the name of a group of viruses that includes more than 100 different strains or types; more than 30 of these viruses are sexually transmitted and none of them are curable, although for some women symptoms may clear up on their own. See the CDC HPV site for more information.

How It Is Spread – Via vaginal, anal and (less commonly) oral intercourse, and through skin-to-skin contact of infected areas, and from mother to child during birth. Carried on the skin and mucus membranes of infected individuals. This means that condoms do not necessarily prevent the spread of HPV. HPV is so common that at least 50% of sexual active people will have it at some point in their lifetime, with much higher estimates for the current college population.

Symptoms – A few of the 30 sexually transmitted strains of HPV are known to cause visible genital warts. Other symptoms are rare. While less than 1% of infected individuals show obvious genital warts, people caring HPV who do not show symptoms can still transmit the virus to others Strains that cause genital warts are least likely to cause cancers. The high risk HPV linked with cervical cancer is often cleared out by the body’s immune system but about 10% of women with high risk HPV will develop infections that can put them at increased risk for cervical cancer.

Testing – The HPV test on the market is only used as part of cervical cancer screening (a Pap smear) which should be a part of women’s annual pelvic exams (for sexually active women or women over 18). There is currently no FDA-approved test for HPV in men. Men with genital warts should see their doctor. There is no general test for men or women to check one’s overall “HPV status” so be aware that even a “full panel” of STI testing does not include this.

Treatment & Prevention – Genital warts can be removed through a variety of methods, most rather expensive and fairly painful and not always recommended by healthcare providers. Even if warts have been removed, it is not known for certain whether the person can still pass the viral infection on to others according to the CDC. However, there is a vaccine available in the United States that has been approved by the US Food and Drug Administration. This vaccine (called Gardasil) is approved for females between the ages of 9 and 26, although some healthcare providers offer it “off-label” to women who are older than 26. This vaccine (which some refer to as the “cervical cancer vaccines” even though it cannot prevent all types of cervical cancer) is highly effective at reducing the risk of acquiring 4 strains of HPV that are strongly associated with cervical cancer and genital warts. You can learn more about the vaccine by clicking here.

Men and women should regularly inspect their genitals for signs of infection, and women should schedule regular pap smears. You may be able to reduce your risk of infection during vaginal and anal intercourse by using latex or polyurethane condoms, and by using condoms or dental dams during oral sex. That said, because HPV is transmitted from skin to skin contact, it is unclear to what extent condoms and dental dams reduce HPV risk as they cannot cover all of one’s genital skin. Some healthcare providers feel that using the female condom may provide more protection than male condoms because they cover more skin. Talk to your healthcare provider about this option. Know your partner’s history and be honest about yours.

Herpes Simplex Virus (HSV)

Genital herpes is caused by herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most people have no or very few signs or symptoms from HSV-1 or HSV-2 infection.

How It Is Spread – Genital HSV is spread via vaginal, oral and anal intercourse; and via kissing. Carried in vaginal secretions, pre-ejaculate, semen, saliva, blood, and on the skin surface and from contact with the HSV sores.

Symptoms – Like a lot of STIs, most people with HSV are not aware of any symptoms. If symptoms do appear (from 2 to 20 days after infection) they are usually a rash of blistery, often painful sores. Person is infected as long as sores are present, and sometimes even when no sores are present and, according to the CDC, people diagnosed with a first episode of genital herpes can expect to have several (four or five) outbreaks within a year.

Testing – Because the signs and symptoms of HSV-2 can vary greatly, it is important to see a health care provider to get a diagnosis, through either visual inspection and taking a sample from the sore(s) and testing it in a laboratory. HSV infections can be diagnosed between outbreaks by the use of a blood test, which detect antibodies produced by the immune system after infection.

Treatment & Prevention – There is no cure for genital herpes but symptoms may be controlled with medication. Protect yourself with latex or polyurethane condoms during vaginal or anal intercourse, and dental dams or condoms during oral sex. Know your partner’s history and be honest about your own. For more information, see The International Herpes Management Forum or the CDC herpes website.

Hepatitis B Virus (HBV)

Hepatitis B is a contagious liver disease that results from infection with the hepatitis B virus. HBV can be mild (acute Hep B infection) or severe (chronic Hep B) based on the duration of the illness.

How It Is Spread – HBV can spread via vaginal, oral, and anal intercourse, and is very infectious. It is also carried in vaginal secretions, pre-ejaculate, semen, saliva, and blood. Hep B can also be spread through contact with other body fluids (like blood) through sharing needles or other drug-injection equipment.

Symptoms – Symptoms generally appear between 45-140 days, typically about 4 months after infection, after the person has already been infectious for several weeks. They can include headache, extreme fatigue, nausea, and tenderness in the lower abdomen. Later, when the disease beings to affect the liver, it can cause jaundice and extreme liver dysfunction.

Testing - Doctors diagnose the infection using one or more blood tests.

Treatment & Prevention – There is currently no treatment or cure for HBV. While symptoms generally clear within 4-8 weeks, the infected person carries the virus for the rest of his or her life. Some people stay infectious, while others never are after the initial illness. HBV is the only viral STI preventable with a vaccine. Get vaccinated, and protect yourself with latex or polyurethane condoms during vaginal or anal intercourse, and dental dams or condoms during oral sex. For more information, see The Hepatitis B Foundation.

Human Immunodeficiency Virus (HIV)

HIV stands for human immunodeficiency virus, which is the virus that causes AIDS. HIV attacks the immune system and can increase your risk for catching other STIs.

How It Is Spread – HIV is transmitted through contact with infected bodily fluids like blood, semen, and vaginal secretions. This means it can be spread cia vaginal or anal intercourse, from mother to child during birth or through breast-feeding. Also potentially transmitted through oral intercourse (still controversial!). Carried in semen, pre-ejaculate, vaginal secretions, blood, and breast milk.

Symptoms – No symptoms may appear for many years following infection. “Early” symptoms of HIV can include rapid weight loss, headaches, a thick, white coating of yeast on the tongue, chronic PID or yeast infections, and purple spots on the skin. HIV causes Acquired Immunodeficiency Disease (AIDS), which weakens the immune systems and allows for the invasion of other diseases into the body.

Testing – The most common HIV tests use blood to detect HIV infection by looking for HIV antibodies. Tests using saliva or urine are also available. Some tests take a few days for results, but rapid HIV tests can give results in about 20 minutes. All positive HIV tests must be followed up by another test to confirm the positive result. Results of this confirmatory test can take a few days to a few weeks.

Treatment – There is currently no cure for HIV; once infected, you carry the virus for the rest of your life. A combination of medications and healthy lifestyle can extend healthy life for decades. However, AIDS is a fatal disease with no known cure. Protect yourself with latex or polyurethane condoms during vaginal or anal intercourse, and dental dams or condoms during oral sex. For more information, see The Body.

Other Infections

Pubic “Crab” Lice

Lice are parasitic insects that can be found on people’s heads, and bodies, including the pubic area. Human lice survive by feeding on human blood. Pubic lice typically are found attached to hair in the pubic area but sometimes are found on coarse hair elsewhere on the body (for example, eyebrows, eyelashes, beard, mustache, chest, armpits, etc.).

How It Is Spread – Pubic lice infestations (pthiriasis, pronounced THIR-i-a-sus) are usually spread through sexual contact. Dogs, cats, and other pets do not play a role in the transmission of human lice.

Symptoms – Pubic (“crab”) lice are not known to transmit any disease. Itching in the pubic and groin area is the most common symptom. As with other lice infestations, intense itching leads to scratching which can cause sores and secondary bacterial infection of the skin.

Testing – Pubic lice infestation is diagnosed by finding a “crab” louse or eggs on hair in the pubic region or, less commonly, elsewhere on the body (eyebrows, eyelashes, beard, mustache, armpit, perianal area, groin, trunk, scalp). Although pubic lice and nits can be large enough to be seen with the naked eye, a magnifying lens may be necessary to find lice or eggs.

Treatment & Prevention – Both over-the-counter and prescription medications are available for treatment of pubic lice infestations. Prevention is mainly about avoiding contact with an infected person (especially sexual contact) until the infested person has been treated. Any clothing and bedding used by the infested person should be washed in  hot water (at least 130°F)  and the high heat drying cycle. Clothing and items that are not washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks.
Do not share clothing, bedding, and towels used by an infested person. Do not use fumigant sprays or fogs; they are not necessary to control pubic (“crab”) lice and can be toxic if inhaled or absorbed through the skin.

Trichomoniasis

Trichomoniasis or trich is a common STD that affects both women and men, although symptoms are more common in women that is caused by a parasite. It is the most common curable STD in young, sexually active women (an estimated 7.4 million new cases each year).

How It Is Spread – Sexual contact spreads trichomoniasis through contact with either the vagina in women or urethra in men.

Symptoms – Like most STIs, most men with trich don’t have any symptoms but some might have irritation or slightly burning after urination or ejaculation. Some women don’t show symptoms either, but those that do might have a frothy, yellow-green vaginal discharge with a strong odor. Symptoms appear within 5 to 28 days of exposure.

Testing – A healthcare provider can perform a physical exam as well as take a sample from the infected area for lab testing. A pelvic exam for women can also help find any ulcerations (sore) on the vaginal wall or cervix (the cause of the irritation some women experience).

Treatment & Prevention – Trichomoniasis can be treated with prescription medication taken orally. Infected men may not have symptoms but can still infect or re-infect partners until he has been treated. You can be re-infected with trich even after successful treatment. Latex condoms can reduce the risk of getting trich and, as usual, if you have any unusual discharge, burning or irritation in your genitals, you should see a doctor before engaging in any sexual activity to rule out infection or disease.

Yeast Infections

A yeast infection is irritation of the vagina and the area around it called the vulva, which comes from a type of fungus called Candida albicans. Yeast infections are very common. About 75 percent of women have one during their lives. And almost half of women have two or more vaginal yeast infections. Men can also get genital yeast infections. A yeast infection in the mouth, throat or tongue is called “thrush.”

How It Is Spread – Yeast infections occur when the normal yeast in the body grows too much, usually when you have a weakened immune system. While yeast infections are not caused by sex, sex can irritate the area or you can transfer a yeast infection back and forth with a partner if you either of you already has one.

Symptoms – The most common symptom of a yeast infection is extreme itchiness in and around the vagina or redness and irritation of the penis or scrotum in men. Other common symptoms in women are burning or redness in and around the vagina, pain with urination or sex, and a thick, white discharge that looks like cottage cheese and does not have a bad smell.

Testing – Your medical provider can take a sample from your vagina (or other infected area) to look for the yeast under a microscope.

Treatment & Prevention – Yeast infections can be cured with antifungal medicines, which can be in the form of creams, tablets, or ointments/suppositories that are inserted into the vagina. Over the counter remedies come in the form of creams or suppositories while the anti-fungal tablets require a prescription from a healthcare provider. It is still important to see a healthcare provider if you think you have a yeast infection so that your doctor can test for it and make sure the symptoms aren’t related to another illness or STI.

You can help prevent yeast infections by taking over the counter supplements or eating foods with a high live bacteria count such as yogurt with Lactobacillus acidophilus (also called L. acidophilus). Boost your immune system as well by getting enough sleep and eating a more balanced diet. Women can avoid yeast infections by avoiding douching (bad idea all around), avoiding scented hygiene products, avoiding tight underwear or synthetic fibers (non-cotton), and changing out of wet swimsuit and exercise clothes.